本文選題：經(jīng)巖骨側(cè)方入路 + 解剖　； 參考：《吉林大學(xué)》2009年博士論文

【摘要】： 本研究的目的是:1、探尋巖斜坡區(qū)的解剖標(biāo)識,并對空間結(jié)構(gòu)進(jìn)行量化。2、進(jìn)一步研究巖斜坡區(qū)神經(jīng)、血管及它們之間的相互關(guān)系。3、圍繞著改善術(shù)區(qū)顯露及減少術(shù)后并發(fā)癥的發(fā)生這一宗旨,對現(xiàn)有的巖斜區(qū)手術(shù)入路進(jìn)行分析、總結(jié)及改良,以期獲得更佳的手術(shù)方案。通過尸頭解剖及在尸頭上模擬手術(shù)入路,尋找更合理的巖斜區(qū)手術(shù)入路。采用方法為對經(jīng)10%福爾馬林固定的成人尸頭進(jìn)行顯微鏡下解剖,進(jìn)一步明確重要骨性結(jié)構(gòu)的標(biāo)志及位置;闡述顱底所有血管的走形、分布、與顱神經(jīng)及腦干的關(guān)系,測量相關(guān)的距離;在尸頭上模擬改良后的巖骨側(cè)方入路。結(jié)果為1、提出外耳道上壁作為磨除巖骨的基本標(biāo)志點(diǎn),以此可對其他標(biāo)志點(diǎn)進(jìn)行判定。2、提出術(shù)中利用腦池交界區(qū)判斷血管的位置。3、提出乙狀竇前置的另外含義,不是乙狀竇與外耳道之間的距離,不僅僅是對乙狀竇與后半規(guī)管之間距離的簡單描述,還應(yīng)包含下列因素:乙狀竇與后半規(guī)管壺腹部的距離;后半規(guī)管與巖尖的距離;乙狀竇的長度;橫竇-乙狀竇交角的角度。4、利用不同腦池內(nèi)血管穿支的分布規(guī)律,可更好的保護(hù)血管。5、應(yīng)用三維螺旋CT對巖斜坡區(qū)的解剖結(jié)構(gòu)進(jìn)行預(yù)先定位,并找出規(guī)律,使手術(shù)預(yù)案更加合理。同時(shí)利用頭部CTA所顯示的腫瘤與血管的關(guān)系指導(dǎo)術(shù)中操作。6、提出了改良的經(jīng)巖骨側(cè)方入路,并提出了此入路需注意的問題。得出結(jié)論為1、外耳道上壁是重要標(biāo)志點(diǎn),它是兩種幕上下雙骨瓣開顱后十分明顯的一個(gè)解剖標(biāo)志,確切的講是顴弓延長線與外耳道上壁的交點(diǎn)。2、在硬膜外操作可磨除三處骨質(zhì),巖尖及巖骨嵴、乙狀竇前及枕骨髁前部。巖尖及巖骨嵴磨除的范圍為前界至外展神經(jīng)穿斜坡處的Dorello管,外側(cè)界至頸內(nèi)動脈巖骨水平段,后界至上半規(guī)管表面,內(nèi)側(cè)界至巖下竇;乙狀竇前骨質(zhì)磨除的范圍是由乙狀竇、頸靜脈球、巖上竇、半規(guī)管及內(nèi)聽道所構(gòu)成的不規(guī)則形區(qū)域中;枕骨髁磨除的范圍是上至乙狀竇第三處轉(zhuǎn)折,前至舌下神經(jīng)管內(nèi)口,下至寰椎髁突,后方接近椎動脈壓跡。3、磨除巖尖、巖骨嵴及乙狀竇前的骨質(zhì),平行巖骨嵴切開小腦幕,輕抬顳葉,可使幕上觀察斜坡的視角擴(kuò)大,在顳葉抬起約22度角時(shí)即可清晰顯示自鞍背至頸靜脈孔的巖斜區(qū)中央部分;將枕骨髁前部磨除,在乙狀竇下方切開硬膜并將乙狀竇向前上方翻轉(zhuǎn),可使下斜坡的暴露更加充分,可在直視下觀察遠(yuǎn)至對側(cè)巖斜裂的下斜坡部分。4、雙骨瓣可用顱骨固定鈦釘確切復(fù)位固定。
[Abstract]:The purpose of this study is to explore the anatomical identification of the petroclival region, to quantify the spatial structure, and to further study the nerves in the petroclival region. According to the purpose of improving the exposure of the operation area and reducing the occurrence of postoperative complications, the existing approaches to the petroclival region were analyzed, summarized and improved in order to obtain a better operation plan. By dissection of cadaveric head and simulated operative approach on cadaveric head, a more rational approach to oblique rock region was found. Methods Anatomy of adult cadaveric head fixed with 10% formalin was carried out under microscope to further clarify the mark and position of important bone structure, to explain the shape and distribution of all blood vessels in the skull base, and the relationship with cranial nerve and brain stem. The relative distance was measured and the modified lateral approach of petrosal bone was simulated on the cadaveric head. The results were as follows: 1. The superior wall of the external auditory canal was proposed as the basic mark point for the removal of petrosal bone, which could be used to judge the other marker points. The location of the vessels was determined by using the cisternal junction area. The additional meaning of the sigmoid sinus anterior position was put forward. The distance between the sigmoid sinus and the external auditory canal is not only a simple description of the distance between the sigmoid sinus and the posterior semicircular canal, but also includes the following factors: the distance between the sigmoid sinus and the posterior semicircular canal ampulla, the distance between the posterior semicircular canal and the petrous apex; The length of sigmoid sinus, the angle of transverse sinusoid to sigmoid sinus, and the distribution of perforating branches in different cerebral cisterns can better protect blood vessels .5. the anatomical structure of petroclival region can be prepositioned by three-dimensional spiral CT, and the regularity can be found out. Make the operation plan more reasonable. At the same time, the relationship between tumor and blood vessel displayed by head CTA was used to guide the operation of .6. the modified lateral approach of petrosal bone was proposed, and the problems needing attention in the approach were put forward. In conclusion 1, the superior wall of the external auditory canal is an important marker, which is a very obvious anatomic marker after the craniotomy of the upper and lower tentorial double bone valves. The exact point is the intersection of the extension line of the zygomatic arch and the superior wall of the external auditory canal. Petrous apex and petrous crest, anterior sigmoid sinus and anterior occipital condyle. The range of petrous apex and petrous ridge grinding is from the anterior boundary to the Dorello canal through the Clivus of the abducens nerve, from the lateral boundary to the horizontal segment of the petrous bone of the internal carotid artery, from the posterior boundary to the surface of the semicircular canal, from the medial boundary to the inferior petrosal sinus, and from the sigmoid sinus to the anterior sigmoid sinus. In the irregular region of jugular bulb, superior petrosal sinus, semicircular canal and internal auditory canal, the condyle of occipital bone is removed from the third turn of the sigmoid sinus, from the anterior to the internal orifice of the hypoglossal canal, down to the atlas condyle, The posterior approach to vertebral artery indentation. 3, grinding the bony bone in the petrous apex, petrous crest and presigmoid sinus, parallel petrosal crest incision of the tentorium, gently lifting the temporal lobe, can enlarge the angle of view of the Clivus on the supratentorial. When the temporal lobe is raised at an angle of about 22 degrees, it is clearly shown from the back of the saddle to the central part of the oblique petrosal region of the foramen jugular; the anterior part of the condyle of the occipital bone is removed, the dura is cut below the sigmoid sinus and the sigmoid sinus is turned forward and the lower slope is exposed more fully. It can be observed as far as the lower slope of the contralateral diagonal fissure. The double bone flap can be fixed with titanium nail.
【學(xué)位授予單位】：吉林大學(xué)
【學(xué)位級別】：博士
【學(xué)位授予年份】：2009
【分類號】：R651;R322

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